Relationship between peripheral blood endotoxin, toll-like receptor 4 expression, and postoperative infection following surgery for acute appendicitis.

BACKGROUND: Acute appendicitis, a common condition with a higher prevalence among men, has shown an increasing incidence in recent years owing to lifestyle changes. It is characterized by right lower quadrant abdominal pain, rebound tenderness, and rapid onset. Its pathogenesis is complex and potentially linked to infection, environment, and genetics. Timely intervention is crucial to prevent complications. While surgery is the primary treatment, it carries risks, including postoperative infections that may necessitate re-operation. Gram-negative bacteria release endotoxin (ETX), which induces inflammation and is recognized by toll-like receptor 4 (TLR4). This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections, aiding in prevention and treatment.

AIM: To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.

METHODS: A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024 (n = 153) were included in the study. Patients were categorized into infected (n = 36) and uninfected (n = 117) groups according to the development of postoperative incision infections. General characteristics and blood levels of ETX and TLR4 were compared, and the factors influencing postoperative infection were identified using multivariate logistic regression. ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.

RESULTS: No statistically significant differences were observed between the two groups in terms of sex, age, or other general characteristics (P > 0.05). Compared to the uninfected group, the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis, longer surgical times, longer incision lengths, and elevated ETX and TLR4 levels (P < 0.05). Multivariate logistic regression analysis identified pathological type, surgical method, surgical time, and incision length as factors influencing postoperative incision infection in acute appendicitis. Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection, with higher prediction efficiency when combined.

CONCLUSION: Pathological type, surgical method, surgical time, and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis. Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.